A royal hip draws media attention to the challenge of having a replacement

Ruth ten Hove, head of research and development, talks about the Duke of Edinburgh's hip surgery and how the CSP is working with experts to improve hip fracture rehab pathways

by Ruth ten Hove

From time to time, my job is extraordinary - today was one of those times.

A call from the CSP press team, and then the BBC and I was on my way to Broadcasting house to sit in a pod and talk to ten regional radio stations about the likely recovery and rehab for Prince Philip, following his hip surgery.

Questions ranged from the risks of surgery at his age, to what would be included in a rehab programme to his likely attendance at Prince Harry’s wedding.

The experience took me back in time to November 1995, when I was interviewed for ITN news, that time about the Queen Mother’s recent hip replacement. She was 95, I do not remember her age being such as issue, but there were still lots of questions about her likely recovery. She did amazingly well, and lived another seven year.

So more than twenty years have passed between those two royal hip related stories and my own knowledge base has grown significantly in that time. I have been most fortunate to have had close connections with the Falls and Fragility Fractures Audit Programme.

I have seen outstanding improvements in the care of very old frail people who have required hip surgery, through the development of standards and the capture and scrutiny of routine data on the National Hip Fracture database (NHFD).

Mortality rates have halved in that time, and modern anaesthesia and surgery are now so successful that nearly all patients have prompt and effective repair of their injury and most are able to get out of bed by the day after surgery.

Yet we are still at the beginning of really understanding the challenges faced by frail and older patients as they persevere to get back to previous mobility, independence and quality of life. 

The results from Hipsprint have given us a great starting point, we can now be certain that there is unwarranted variation in the whole hip fracture rehab pathway  – from acute based early mobilisation through to community based rehabilitation and recovery.

So how can we improve things? We are working with expert members and the NHFD, to develop a range of resources, which will help physios to reduce this variation and provide consistently high standards of care.

Our first project is the development of two standards, one relating to early care and the other to transfer of care into the community, which we will shortly share for consultation through the icsp network.

So do take a look and tell us what you think. We also want to hear your stories – of things that have gone well or things to learn from. It is only by using honest and objective appraisal that we can really make significant improvements to patient care.

Ruth ten Hove is head of research and development at the CSP.

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